COMPARISON OF POST-OPERATIVE D-DIMERS LEVELS IN OPEN VS LAPAROSCOPIC CHOLECYSTECTOMY: AN OBSERVATIONAL COMPARATIVE STUDY

Abstract

Background: Cholecystectomy is one of the most commonly performed surgical procedures worldwide, traditionally via open surgery (OC) but increasingly by laparoscopic cholecystectomy (LC). Although laparoscopic approaches are associated with reduced morbidity and shorter recovery, biochemical markers such as D-dimer, indicative of thrombotic and fibrinolytic activity, may provide further insights into postoperative outcomes. Elevated D-dimer levels following surgery are linked with increased risk of thromboembolic complications, making their evaluation clinically relevant.

Objective: To compare postoperative changes in D-dimer levels between open and laparoscopic cholecystectomy and assess their implications for patient management.

Methods: This observational comparative study was conducted at the Department of Surgery, Unit II, Holy Family Hospital, Rawalpindi, Pakistan, from July 2022 to December 2022. A total of 80 patients with chronic cholecystitis were enrolled (40 OC, 40 LC). Exclusion criteria included coagulopathies, acute inflammation, malignancy, and conditions predisposing to elevated D-dimer. Blood samples were collected preoperatively, at 12 hours, 48 hours, and on the 5th postoperative day. D-dimer levels were measured using standardized immunoassays. Statistical analysis was performed with SPSS v23, using t-tests and chi-square/Fisher’s exact tests, with significance set at p < 0.05.

Results: The mean age of patients was 40.6 ± 10.6 years, with females predominating (76%). Preoperative D-dimer levels were significantly higher in the OC group (139.75 ± 38.73 ng/mL) than the LC group (120.50 ± 31.62 ng/mL, p = 0.017). At 12 hours and 48 hours postoperatively, D-dimer levels rose markedly in both groups, peaking at 231.25 ± 61.78 ng/mL (OC) and 209.25 ± 58.63 ng/mL (LC), though differences were not statistically significant. By day 5, D-dimer values declined but remained significantly higher in OC (183.00 ± 42.86 ng/mL) compared to LC (160.00 ± 44.49 ng/mL, p = 0.021). Within-group analysis confirmed significant increases from baseline at all postoperative intervals in both groups (all p < 0.001).

Conclusion: Both open and laparoscopic cholecystectomy are associated with significant postoperative rises in D-dimer, peaking at 48 hours and declining by day 5. However, open cholecystectomy consistently showed higher absolute D-dimer values, suggesting greater thrombotic activation. These findings reinforce the clinical advantage of laparoscopic approaches in minimizing systemic coagulation responses and highlight the need for vigilant postoperative monitoring of coagulation parameters, particularly in high-risk populations.